Thursday, June 19, 2008

Testosterone does good things for a body, both male and female. It increases bone density, muscle mass, mental acuity, increases metabolism, enhances libido and according to this research, fights against metabolic syndrome in older men. So researchers are encouraging older men to supplement with testosterone.

Futurepundit (via Instapundit)worries about the evolutionary implications of declining testosterone in older men and that it might be a protective adaptation against diseases like cancer (since hormones, especially testosterone and estrogen can be tumor growth factors). Maybe.

Testosterone, for men, is the defining, healthy hormone just as progesterone, is the defining, healthy hormone for women. For both men and women the ratio of testosterone:estrogen and the ratio of progesterone:estrogen changes as they age. In both cases, estrogen increases proportionally. Part of it is age. Part of it is diet. Part of it is environmental. Estrogens are everywhere in the environment--from plastics to soy. Fat stores and releases estrogen. Estrogen, in and of itself, isn't bad, but it can be problematic when it's in the wrong proportion to testosterone and progesterone.

So, men can supplement with testosterone and women can supplement with progesterone and testosterone, too, for that matter, and this will happen: the body will down-regulate. That is, the body will stop producing as much testosterone and progesterone in response to the supplementation. This happens with all hormones which is why, once a person is on Synthroid, (synthetic thyroid hormone) he or she is on it for life. The body will stop producing it.

Now, there are vegetable-based hormone replacements that are less manipulative of the system and they can give the body a rest to recover, but the ideal is to produce these hormones oneself without the aid of supplementation. The answer to hormone balance is simple, but no one wants to do it because it's certainly not as easy as a supplement:

Keep moving. It's not just the muscle, it's the metabolic rate. Aerobic exercise burns off the stress hormones that cause you to accumulate fat in the first place (which stores estrogen). So work up a sweat a couple days a week.

Get some sun. Without Vitamin D, all sorts of bad things happen. Increased bone density helps a person carry more muscle mass which helps increase the metabolic rate. See how these things work together?

Unfortunately, as people age, they become more sedentary which itself creates risk factors for Metabolic Syndrome. I have read articles by doctors who have been on long-term supplementary testosterone themselves, and they seem perfectly healthy. I have had patients (women actually) who have supplemented, short term with testosterone, for weight loss. The usage is going up. People are making experiments of themselves.

I suspect that it will be agreed that testosterone has salubrious effects for men and women short term, but like supplementary estrogen, the long-term effects won't become apparent until after years of use. Manipulating mother nature usually has a downside even if it's not immediately apparent.

What would I recommend to my patients? Well, short term use could be beneficial, but long term, the advice would be the same old boring stuff: lose weight, get fit and eat right.